Most mothers could probably recall the day they found out they were pregnant like it was yesterday: where you were standing (or sitting if it involved peeing on a stick), what you were doing, maybe even what you were wearing. There truly is no other feeling like that of becoming a parent. But when you decide that you are done, there may be no other fear like finding out you are going to be a parent again. How can we afford another child? Where will we live? Can I take those sleepless nights again? And while we definitely don’t have the answers to these questions (trust us, we live in New York City and get the space thing!), we do have suggestions on how to avoid having such things happen. Simply stated, we offer: permanent contraception.
It’s funny, women ask each other the question “Are you done?” all the time. And without more than those three little words, we know exactly what the question means. Are you having more kids? Cutting, tying, blocking, or clogging are common ways to permanently turn the system off. Both women and men can undergo procedures that will make getting pregnant without any fertility assistance nearly impossible (nothing is impossible because all methods, even the forms discussed below, have a failure rate).
The options available to women all center on blocking an egg from meeting a sperm, a.k.a. tying, cutting, or blocking the fallopian tubes. Tubal sterilizations can be done immediately after a woman has a baby, a few weeks after a baby, or years after a baby. When the former is done, a small incision is made below the belly button, and the tubes are found and subsequently cut/tied. When done weeks or years later, the procedure is most commonly performed through a camera (medically termed a laparoscope). The laparoscope is inserted through the belly button, and the surgery is performed through three tiny holes (one in the belly button and two above the hipbone). When done this way, the tubes are most frequently burned and cut (although a clip can also be placed).
Last, GYNs now have the ability to place a spring-like device (think a Slinky) into the fallopian tubes through the vagina. Again, a camera is inserted, but rather than placing it into the belly button, it travels through the vagina, past the cervix, and into the uterus. Under direct visualization, these springs are deployed into the tube; in the months following their insertion, the body forms scar tissue around them. Together, a serious roadblock is formed and it becomes nearly impossible for anything (including those swimmers) to get through. The caveat here is that you need to make sure all systems are a no go before having unprotected intercourse. Therefore, a hysterosalpingogram (a.k.a. HSG or dye test) must be performed approximately three months after the device is placed to confirm that the tubes have become a steel trap. Once the red light is seen, you get the green light for unprotected intercourse.
While women often find themselves in the driver’s seat for permanent contraception, the number of men electing to undergo a vasectomy is rising. Similar to what happens to a woman’s tube, a man’s vas deferens is “interrupted.” The vas deferens (like the fallopian tube) also serves as a tunnel, transporting sperm from the testes to the urethra. So while the path out may be closed after a vasectomy, men who have had a vasectomy are still producing sperm. The testicles go on as usual, producing both sperm and testosterone, ignorant that their hard work is for naught!
The procedure has no impact on a man’s ability to achieve an erection or to ejaculate. The prostate, the ejaculatory duct, the seminal vesicles, and the glands are all functioning as is, and while the ejaculate is devoid of sperm, it is chock full of other products. While post-operatively there is some pain, in most cases a little Advil and Tylenol should do the trick. It’s quick (usually no more than 15 minutes) and can be performed in the office. The biggest point to stress is that, similar to female sterilization, in which spring-like devices are placed into the tubes, a three-month wait period is required before it’s safe to use this as reliable contraception.
If you should have a major change of heart, there are ways to undo the undoable. Fertility treatment has found a way around tubes that have been tied or sperm that has been stopped. Although it requires in-vitro fertilization, IVF allows women a second (or third or fourth) chance if they should want it. In reality, both men and women who have undergone a tubal sterilization or a vasectomy are still producing both eggs and sperm. They are just no longer able to meet up with each other (think being grounded and stuck in your room).
Fertility doctors have the ability to go right to the source (ovary or testes) and get the goods (egg or sperm). So while we recommend you be certain about your decision before taking the leap, remember there is always a back-up plan should you change your mind.